Sugino Fumiya, Ishida Takashi, Tamaki Masayoshi, Komeda Hisao, Watanabe Naoki, Tanaka Takuji
The Department of Urology, Gifu Municipal Hospital.
The Department of Diagnostic Pathology, Gifu Municipal Hospital.
Hinyokika Kiyo. 2022 Aug;68(8):277-280. doi: 10.14989/ActaUrolJap_68_8_277.
A 36-year-old man presented with painless swelling in the right side scrotum. Ultrasonography showed a hypoechoic tumor with mosaic pattern. Plain computed tomograghy (CT) revealed a 67 mm scrotal cystic lesion with low density area. We suspected an intrascrotal tumor and performed right side radical orchiectomy. The removed sample was yellow clear and elastic hard. A 7 cm multilocular cystic tumor was present on the head side of the normal testis. The cut-surface and the contents of the mass revealed a jelly-like viscous liquid. On the microscopic examination, the tumor was composed of mucinous stroma and spindle-shaped atypical cells with hyperchromatic oval nuclei and eosinophilic cytoplasm. There was a characteristic network of blood vessesls with hyperhyalinization in the myxoid zones. Immunohistochemically, CDK4, MDM2, AE1/AE3, S-100, Alpha-SMA and desmin were negative, but MUC4 showed focal cytoplasmic positivity in the neoplastic cells. In the reverse transcription polymerase chain reaction assay, no FUS-CREB3L2/FUS-CREB3L1 fusion transcripts were identified although the detectable messages of the housekeeping genes were noted. The tumour was finally diagnosed as a paratesticular low-grade fibromyxoid sarcoma. Postoperative course was uneventful and no recurrence or metastasis was seen four months after the operation.
一名36岁男性因右侧阴囊无痛性肿胀就诊。超声检查显示一个具有镶嵌模式的低回声肿瘤。普通计算机断层扫描（CT）显示一个67毫米的阴囊囊性病变，伴有低密度区域。我们怀疑是阴囊内肿瘤，遂进行了右侧根治性睾丸切除术。切除的样本呈黄色清亮且质地硬韧。在正常睾丸的头侧有一个7厘米的多房囊性肿瘤。肿块的切面和内容物显示为果冻样粘性液体。显微镜检查显示，肿瘤由粘液性间质和梭形非典型细胞组成，细胞核椭圆形、染色质增多，细胞质嗜酸性。在粘液样区域有一个特征性的血管网络伴玻璃样变性。免疫组化检查显示，细胞周期蛋白依赖性激酶4（CDK4）、小鼠双微体2（MDM2）、细胞角蛋白AE1/AE3、S-100蛋白、α-平滑肌肌动蛋白（Alpha-SMA）和结蛋白均为阴性，但粘蛋白4（MUC4）在肿瘤细胞中显示局灶性细胞质阳性。在逆转录聚合酶链反应检测中，虽然看家基因的可检测信息被记录到，但未发现FUS-CREB3L2/FUS-CREB3L1融合转录本。该肿瘤最终被诊断为睾丸旁低级别纤维粘液样肉瘤。术后病程顺利，术后四个月未见复发或转移。
